RECONSTRUCTION OF LARGE PALMAR DEFECTS OF THE HAND USING FREE FLAPS

The reconstruction of large palmar defects of the hand remains a diffi cult problem due to the specific anatomical structures and highly soph isticated function of the palm. The glabrous skin and subcutaneous tis sue in the palm are perfectly adapted to serve the prehensile function . The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. R estoration of sensibility is desirable. For smaller defects a great va riety of local pedicled or island flaps can be applied. However, for l arger defects with exposed tendons, nerves or other essential structur es, free flaps remain as a reliable alternative. This paper reviews ou r approach of soft tissue reconstruction in 16 patients with large pal mar defects using various kinds of free flaps. The advantages, disadva ntages and current indications for free flap resurfacing of the palm a re discussed.